Mastectomy, Body De-Construction and Impact on Identity: A qualitative study

Objectives: This qualitative study aims at understanding the consequences of body deconstruction through mastectomy on corporality and identity in women with breast cancer. Design: Nineteen women were contacted through the hospital. All had to undergo mastectomy. Some were offered immediate breast reconstruction, others, because of cancer treatments, had no planned reconstruction. A qualitative reflexive methodological background was chosen. Method: Women were invited to participate in three semi-structured interviews, one shortly before or after mastectomy, and the other interviews later in their illness courses, after surgery. All interviews were transcribed verbatim. Thematic analysis was performed. The analysis of the first interview of each woman is presented in this article. Results: Mastectomy provokes a painful experience of body deconstruction. Even when immediate reconstruction is proposed, contrasted feelings and dissonance are expressed when comparing the former healthy body to the present challenged body entity. Body transformations are accompanied with experiences of mutilation, strangeness, and modify the physical, emotional social, symbolic and relational dimensions of the woman's gendered identity. Although the opportunity of breast reconstruction is seen as a possible recovery of a lost physical symmetry and body integrity, grieving the past body and integrating a new corporality leads to a painful identity crisis. Conclusion: With mastectomy, the roots of the woman's identity are challenged, leading to a re-evaluation of her existential values. The consequences of mastectomy transform the woman's corporality and embodiment, and question her identity. Psychological support is discussed in the perspective of our results.

Specificities of psychodynamic psychotherapy in the medically ill

Psychodynamic psychotherapy with patients suffering from somatic diseases is based on general principles of psychodynamic understanding, such as the influence of development and biographical elements on patient.s adaptation to illness or the role of defense mechanisms when facing existential threat. However, differences exist, such as the adaptation of the therapeutic setting, which thus loses some of its diagnostic and therapeutic power, or the early emergence of powerful transference, which cannot always be interpreted by the therapist. In addition, psychodynamic psychotherapy in the medically ill has some specificities, which differentiate it from classical psychoanalytic theory. The specificities concern, for example, transference of the medically ill, which is more adequately conceived by concepts of the existential analysis (Daseinsanalyse), or the patient.s loss of a sense of continuity, which needs an understanding beyond psychological theory taking into account philosophical (e.g. phenomenology), anthropological and ethical concepts.

Challenges to patient-centred care in a general internal medicine context: findings from an exploratory study

Introduction. If we are to promote more patient-centred approaches in care delivery, we have to better characterize the situations in which being patient-centred is difficult to achieve. Data from professionals in health and social care are important because they are the people charged with operationalizing patient-centred care (PCC) in their daily practice. However, empirical accounts from frontline care providers are still lacking, and it is important to gather experiences not only from doctors but also from the other care providers. Indeed, experiences from different professions can help inform our understanding of patient care, which is expected to be both patient-centred and collaborative. Methods. This study was based on the following research question: What factors make the provision of PCC difficult to achieve? Sample and setting. A purposeful sampling technique was used, allowing for a series of choices about the participants and their professional affiliation. Because patient-centredness is the focus, 3 professions appeared to be of special interest: general internists, nurses and social workers. The study was undertaken in the General Internal Medicine Division of a teaching hospital located in a North American context. Data Collection. To answer the research question, a methodological approach based on a theory called phenomenology was chosen. Accordingly, semi-structured interviews were used since they generate understanding of the meanings different individuals have of their lived world. Interviews with 8 physicians, 10 nurses and 10 social workers were eventually conducted. Data analysis. An inductive thematic analysis was employed to make sense of the interview data. Results. The thematic analysis allowed identifying various types of challenges to PCC. Although most of the challenges were perceived by all three groups of professionals, they were perceived to a different degree across the professions, which likely reflected the scope of practice of each profession. The challenges and their distribution across the professions are illustrated in Table 1. Examples of challenges are provided in Table 2. Discussion. There is a tension between what is supposed to be done - what stands in the philosophy of patient -centredness - and what is currently done - the real life with all the challenges to PCC. According to some participants' accounts, PCC clearly risks becoming a mere illusion for health care professionals on which too great pressures are imposed.

La controverse avant le film : quelle politique pour Good Night, And Good Luck ?

This article aims to explain how newspapers commented on the movie Good Night, and Good Luck before its release. The media coverage anticipated George Clooney's film as a partisan attack launched against George W. Bush's policy since 9/11. Clooney advocates another reading: the historic confrontation between journalist Edward Murrow and Senator Joseph McCarty permits to reflect on the crucial role that the media play for democracy. Such reflection tries to prevent the dividing of the public sphere into antagonistic camps opposing "friends" to "foes," a division that undermines the possibility of a true pluralism. Our socio-semiotic analysis will focus on the critical work accomplished by the media, and on the way that work determines the collective meaning of a cultural object. Simultaneously, we will discuss the necessary conditions for pluralism in a public sphere.

El Camino de Santiago : Estudi qualitatiu sobre vivències i relacions amb un camí interior

Estudi sobre la vivència i les relacions entre pelegrins dins l'espai del Camino de Santiago, entès com un entorn ple de simbolismes religiosos, no religiosos i socials. La branca d'estudis culturals aporta l'anàlisi de valors, creences, comportaments i simbologia de l'entorn, així com la seva implicació amb aquests comportaments. Com a conceptes importants per aprofundir hi ha els valors, l'experiència individual i comunitària, el camí existencial, el camí social, la interrelació o el contacte.

La radicalización Heideggeriana del método fenomenológico

Este trabajo quiere esclarecer cómo y por qué, en la doctrina del «primer» Heidegger,la hermenéutica emerge como el complemento metodológico indispensable para el transcendentalismo de la fenomenología. Constata que la afinidad metodológica es el vínculo decisivo entre esta doctrina y la ontología fundamental, en contraste con una manifiesta disparidad temática: la conciencia, la intencionalidad y la reflexión son tres cruciales referenciasfenomenológicas que carecen de contrapartida fundamental-ontológica. Pero si Heidegger preserva la dimensión transcendental recogida de la fenomenología, tambiénimprime a su doctrina un carácter específicamente hermenéutico, patente en la transformación que recibe la noción capital de Auslegung. Hermenéutica y transcendentalismo, en efecto,no sólo no son antagónicos sino que estjn armonizados en el rnodus operandi de la ontología fundamental. En su indagación del a priori de toda constitución de sentido, tributaria de un antideductivismo tan exacerbado como el de la fenomenología, Heidegger introduce una dimensión metodológica inédita. Al fin y al cabo, la automostración del ser no ocupa el lugar teórico, supuestamente ametódico, que la fenomenología asigna a la in-mediatez.Entender esta mutación del método fenomenológico, desde luego, conlleva explorar en detalle cómo integró Heidegger las dispares componentes doctrinales de la ontología fundamental y por qué se empeñó en cuestionar el carácter neutral que se suele exigir al método.Transponiendo el transcendentalismo presencialista de Husserl en un proyecto ontológico, reinterpretó la metodología de la «intuitividad presentificadora» hasta hacerla compatible con una noción radicalmente ampliada de fenómeno. Así una indagación fenomenológica legítima ha de investigar transcendentalmente el «sentido del ser» como el apriori absoluto.La fenomenología ha de ser realizada como ontología.

Estructuración natural de las relaciones entre sonidos de altura definida : aproximación fenomenológica a las relaciones tonales

La mayoría de tratados de armonía enfocan las relaciones armónicas como el resultado de unas combinaciones concretas y hasta cierto punto aleatorias de sonidos y solamente muy de vez en cuando encontramos justificaciones de por qué unos determinados procesos armónicos tienen un resultado vivencial específico; incluso en esos casos, las explicaciones se quedan habitualmente en nada. En este trabajo estudiaremos a fondo cuáles son los fundamentos esenciales sobre los que se basa la música, entendida como un encadenamiento de frecuencias que, si bien es solamente una parte del todo musical, constituye un elemento muy importante. Para ello, la fenomenología de la música –el estudio del efecto de los sonidos sobre la conciencia humana– nos proporcionará las herramientas necesarias.

Vårdande och icke-vårdande tröst

The aim of the thesis is, from a caring science perspective including a caring theology perspective, to illustrate the meaning of the phenomenon consolation and howconsolation relates to suffering and care. Two studies were completed where staff and elderly care receivers were interviewed and a third study focused on an analysis of consolation as it is presented in the Book of Job in the Old Testament. These studies deal with carers' experiences of consolation and consoling, elderly care receivers' experiences of consolation, and Job's experience of consolation. Phenomenology and hermeneutics form the basis for the methodological approach. A phenomenological- hermeneutic method, inspired by Paul Ricoeur, has been used for the text analyses. The thesis also covers significant aspects of poetical and religious texts. The metaphors that occur in the interview studies with the carers and the elderly are analysed in order to take care of the excess of meaning that, according to Ricoeur, can be expressed in metaphors. The result showfive overall meanings: The contradictory consolation, The bonding consolation, The mute and rigid consolation, The uncontrolled consolation and The restful consolation. A caring consolation is contradictory in the sense that it entails that the sufferer on the one hand passes on his or her suffering to someone else and on the other hand that the suffering can be returned to be suffered. Consolation can thus entail suffering. The bonding consolation is present, i.e. is with the sufferer and is based on that person's suffering. This consolation is characterised by a close fellowship, a feeling of being understood at a deeper level. The results also reveal a consolation that is mute and rigid. This consolation does not respond to the sufferer's experience of his or her suffering, is shapeless and therefore unable to follow the suffering. An example of a mute, rigid and non-caring consolation is the consolation of the friends in the Book of Job. This consolation is not capable of consoling because it does not correspond to where Job is, i.e. in his experience of his suffering. A caring consolation is also uncontrolled because it is on the one hand spontaneous and on the other hand helps the sufferer to lose control over the suffering. To lose control entails, amongst other things, the sufferer giving up trying to understand suffering and instead lets that which is incomprehensible be incomprehensible. A consoling and health-bringing rest in or from the struggle with suffering presents itself by giving up what in various ways is tied to the suffering. The result as a whole is interpreted from a caring science perspective with the following important concepts: caring relationship, faith, health and sacrifice. Consolation as health is considered on the basis of a theoretical model inspired by Katie Eriksson's ontological health model. The research is also illustrated from a philosophical-ethical perspective, mainly based on the work of Emmanuel Levinas. The findings are discussed in relation to previous research and also to caring science, society and care.

Integrating environmental education in primary school education in Tanzania : teachers’ perceptions and teaching practices

The study focuses on primary school teachers’ perceptions of environmental education, its integration into primary school education and teachers’ teaching practices in Tanzania. The thesis is based on empirical research. The theoretical underpinnings of the study are based on Palmer’s (1998) model of environmental education. According to the model, meaningful environmental education should include education about, in or through and for the environment. The study is supported by national and international literature from research done on environmental education and education for sustainable development and policy statements. The study is qualitative in nature, adopting phenomenography and phenomenology as points of departure. The empirical data was collected from four primary schools in Morogoro region in Tanzania. The study sample consisted of 31 primary school teachers. Data was collected through interviews and lesson observations. According to the results of the study, primary school teachers expressed variations in their perceptions of environmental education and education for sustainable development. Most of the teachers focused on the aspect of knowledge acquisition. According to Tanzanian education and training policy, environmental education has to be integrated into all subjects. Although there is environmental education in the primary school curriculum, it is not integrated on an equal footing in all subjects. Some subjects like science, social studies and geography have more environmental content than other subjects. Teachers claim that the approach used to integrate environmental education into the school curriculum was not favoured because many claimed that what is to be taught as environmental education in the various subjects is not shown clearly. As a result, many teachers suggested that to ensure that it is taught properly it should be included in the curriculum as an independent subject or as specific topics. The study revealed that teachers’ teaching practices in integrating environmental education varied from one subject to another. Although most of the teachers said that they used participatory methods, lesson observations showed that they limited themselves to question and answer and group discussion. However, the teachers faced a number of barriers in the teaching of environmental education, some of which include lack of teaching and learning resources, time and large class size. The role of teachers in the implementation of environmental education in developing an environmentally literate citizenry is of great significance. The responsibility of the government in developing a curriculum with clear goals and content, developing teachers’ capacity in the teaching of environmental education and provision of teaching and learning materials needs to be taken seriously by the government in educational plans and programs.

Tyylinä sukupuoli - tyylikäs sukupuoli

Kirjallisuusarvostelu

En gestaltning av individens erfarenhetsbaserade kunskap inom diabetesvården

The aim of this study is to form the experience-based knowledge of diabetics. The broader intent is to be able to transform this experience-based knowledge as an asset within caring. In this study, a theoretical contact for the empirical data is presented through phronesis, i.e. practical wisdom. Phronesis can be seen as the most suitable form of knowledge to be able to deepen the individual's understanding of experiencebased knowledge. For this research, hermeneutic phenomenology was chosen. Abductive reasoning was the method chosen to approach the data collected through repeated deep interviews with individuals with personal experience of diabetes and the use of insulin pumps. The abductive approach fascilitates a broader interpretation of the primary empirical results via a theory of philosophy of science, such as phronesis, the life-world and the negativity of the experience. The latent message of the empirical data is thereby also additionally highlighted. The synthesis reveals that experience-based knowledge arrives with time, it is personified and praxis-oriented, and before this time, the knowledge and security must be provided by the established care, by people close to the individual or by other external sources. The experience-based knowledge has strenghts and weaknesses. The knowledge is further categorized by the individual's ability to discern and make judgement. Additionally, the experience-based kowledge is a reflecting and action-based knowledge striving to improve the care provided. The experience-based knowledge held by the individual is potentially a great instrument towards improving general knowledge with possible practical applications within the diabetic care. Furthermost, in practical suggestions to fascilitate care. In generally applying knowledge gathered from the individual's experiental point of view, there are inherent risks. These risks could potentially be eliminated through the adoption of a concept where the established care could function as a quality guarantor. A concept taking into account the experiencebased knowledge as a source of information and knowledge in the care for diabetics. Co-created knowledge and understanding is a position found in both self-care and pump-treatment. It is also found through the optimal application of the experience-based knowledge of the individual as well as the knowledge found within the established care, in order to fascilitate well-being. This as expressed by the individual's phronesis-based knowledge.

Non-Markovian dynamics and quantum information probes

This Thesis discusses the phenomenology of the dynamics of open quantum systems marked by non-Markovian memory effects. Non-Markovian open quantum systems are the focal point of a flurry of recent research aiming to answer, e.g., the following questions: What is the characteristic trait of non-Markovian dynamical processes that discriminates it from forgetful Markovian dynamics? What is the microscopic origin of memory in quantum dynamics, and how can it be controlled? Does the existence of memory effects open new avenues and enable accomplishments that cannot be achieved with Markovian processes? These questions are addressed in the publications forming the core of this Thesis with case studies of both prototypical and more exotic models of open quantum systems. In the first part of the Thesis several ways of characterizing and quantifying non-Markovian phenomena are introduced. Their differences are then explored using a driven, dissipative qubit model. The second part of the Thesis focuses on the dynamics of a purely dephasing qubit model, which is used to unveil the origin of non-Markovianity for a wide class of dynamical models. The emergence of memory is shown to be strongly intertwined with the structure of the spectral density function, as further demonstrated in a physical realization of the dephasing model using ultracold quantum gases. Finally, as an application of memory effects, it is shown that non- Markovian dynamical processes facilitate a novel phenomenon of timeinvariant discord, where the total quantum correlations of a system are frozen to their initial value. Non-Markovianity can also be exploited in the detection of phase transitions using quantum information probes, as shown using the physically interesting models of the Ising chain in a transverse field and a Coulomb chain undergoing a structural phase transition.

Quality enhancement in teacher education : Tanzanian teacher educators’ conceptions and experiences

The overall aim of this study was to investigate and examine teacher educators’ conceptions and experiences of quality of teacher education. The research interest therefore was two-fold: a) to deepen understanding of the concept quality and b) scrutinize experiences of teacher educators of quality enhancement. To achieve this ambition the study was conducted in the context of a newly established university college-based teacher education in Tanzania. Two research questions guided the study. The first focused on investigating how teacher educators conceived quality in the domain of teacher education and the second intended to explore teacher educators’ experiences of quality enhancement. The theoretical framework of the study centered on the concepts of teacher education, quality, and criteria for quality enhancement. Phenomenographic and phenomenological approaches under the main umbrella of qualitative research design were selected. Twenty five teacher educators participated in the study. Interviews were used for the collection of the data. The results of the first research question, in brief, indicate that teacher educators’ conceptions of quality are expressed in two main categories, namely, outstanding academic scholarship and adequate professional scholarship. Quality as outstanding academic scholarship was illustrated by two subcategories: excellence and positive transformation. While the former was composed of two aspects, the latter was demonstrated by three aspects. Quality as adequate professional scholarship was described in three sub-categories. The first was improved teaching competency, consisting of two aspects. The second was conscious research orientation, which is displayed by three aspects, and the last was enhancing the ability to reflect, represented by two aspects. The results of the second research question, which focused on exploring teacher educators’ experience of quality enhancement, were classified into two main categories of description: insufficient programs of teacher education and unsatisfactory professional development of teacher educators. From the two categories, the strengths, weaknesses, opportunities and challenges related to programs of educating teachers, particularly curriculum development and implementation, and the professional development of educators, were exposed. Since the ambition of conducting the study was to deepen the understanding by producing insight that would act as a platform for appraising and enhancing the quality of teacher education, the results hopefully can be used for the development of the quality of teacher education in Tanzania.

Older Consumers’ Adoption of Online Shopping

The thesis is concerned with the online shopping behavior of older adults, who in this study are at least 60 years old. At the moment, the population is ageing and consumers are buying more and more via the Internet. The objective of the thesis is to understand the large group of older adults in Finland as online customers.The study explores older consumers’ adoption of online shopping with a qualitative research, and it is situated in the research tradition of hermeneutic phenomenology. Phenomenology focuses on the life-world of people. The empirical data was collected by three focus groups with 13 participants altogether. The focus group conversations brought forth that there is not tremendous difference in the motives of older consumers to shop online compared to other age groups. The study strengthened the previous conception of a change toward more ageless market. However, online stores should be designed to accommodate some special needs of older consumers as they occasionally struggle with the logic of websites. Finnish older consumers have adopted online shopping because of perceived convenience and because of tolerable perceived risk during first online shopping experience. Positive experiences strengthen positive attitude toward electronic channel.